Individual
RENAE L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1361 WENNER RD, DETROIT LAKES, MN 56501-7918
(218) 396-6500
(218) 396-6504
Mailing address
1361 WENNER RD, DETROIT LAKES, MN 56501-7918
(218) 396-6500
(218) 396-6504
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9386
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033355
NCCPA-NAT.COMM.CERT.PA
—
01
—
9386
STATE OF MN PA LICENSE
MN
Enumeration date
01/16/2007
Last updated
11/28/2023
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